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Island Forum Explores Paths Toward Change in Health Care System

When's the last time your doctor checked with your chiropractor about that back injury? Or how about that free screening for colon cancer? And what if your teenage daughter told you she'd given up on weekend partying?

If those scenarios sound a little far-fetched, they are - for now.

Sunday night at the Old Whaling Church in Edgartown, some of the nation's - and Island's - best and brightest minds got together to talk about how to make a model health care system happen right here on Martha's Vineyard.

The forum was sponsored by the Dukes County Health Council and the newly formed Foundation for Island Health, which recently won a $50,000 seed grant from the Robert Wood Johnson Foundation to take the first steps toward creating this model on the Island.

"We're a little community, but we're a place with enormous wisdom and talent," said Dr. Charles Silberstein, a Vineyard psychiatrist and the chief executive officer of the Foundation for Island Health. "Where else in the country could you get a panel like this?"

Indeed, the panelists not only made for a formidable lineup, but also for spirited discussion. Professors, physicians, policy-makers and CEOs, they were not afraid to spar with each other.

But despite the combined I.Q., the goal was not intellectual one-upmanship. Dr. Silberstein challenged both panelists and the approximately 300 people in the audience to begin defining a plan that could transform a failed health care paradigm into one that works.

Clearly, that was no simple task, and the question hanging in the air was where to start. Washington insider Dr. Jordan Cohen offered this advice.

"The predominant opinion is that the system is broken," he said. "But the solution is not tinkering around the edges. We'll have to do something fundamental."

But Dr. Cohen, who is president of the American Association of Medical Colleges, warned against a complete overhaul like the one attempted by former President Clinton back in 1993. What's needed, he said, are "incremental changes and models" that put the focus on disease prevention, consistent care and ways in which people's behaviors affect their health.

This was a paradox often repeated through the evening, the challenge of changing something as big and entrenched as health care, but at the same time, starting with small, concrete steps.

But panelist Lou Harris, founder of the famous Harris Poll, offered his cheery prediction that the whole system may begin to crumble soon anyway, making room for alternative models to take their place.

"By 2005, American will have a health care crisis the likes of which we haven't seen in a long time," he said. "HMOs will be abandoned by Wall Street and lose political clout." In the wake of such a collapse, Mr. Harris predicted, "The real action will take place on a community level."

When the discussion turned away from the national scene and back to the Vineyard, the panelists displayed an insight into Island political life. It was Rosabeth Moss Kanter, the Harvard business professor, bestselling author and expert on change, who identified the potential hurdles that could keep the vision from becoming reality.

"A major defeater of change on the Island is turf battles," she said. "Lack of imagination also prevents change. When problems are so complicated, we seem paralyzed."

Judith Kurland, former regional director of the Health and Human Services agency, also addressed this issue of the Vineyard which can be fragmented. "The problem is the community still sees itself as communities and interests," she said.

But the potential for unity is strong, added Ms. Kurland. "The beauty of the Island is that you could have this system. It's small enough, like Cheers, that everybody knows your name," she said. "You have this great infrastructure and a lot of knowledge. You know the problem and you know what could be done."

Dr. Silberstein pointed to the track record of grassroots programs like Hospice of Martha's Vineyard and the Vineyard House, which now runs three residences for men and women in the early stages of recovery from alcohol and drug addiction.

To Ms. Kurland, the issues on the Island do not just revolve simply around access to health care. She rattled off a list of areas: education, nutrition, collaboration, work, income and transportation.

"What makes for a healthy community?" she asked.

That question was not directed at other panelists but really at Islanders. In fact, many panelists made the same point, saying that the success of a new health care model here will depend on the people who live here, answering that question and taking steps to make it happen.

Dr. Roy Vagelos, the former head of Merck Pharmaceuticals, pitched a metaphor of the Island as a benevolent corporation, caring for the health of its employees. "A good business takes care of its people," he said. Programs exist to help people quit smoking, lose weight, screen for diseases and treat drug and alcohol abuse.

"That's what we have to do to attract and retain employees. Can we do this on the Vineyard?" he asked. "Are we willing to have it be part of our culture? We need to ask what are our priorities and then go for it."

If it was a night of unanswered questions, one of the biggest was how much it might cost to go for it. Dr. Silberstein said the changes would pay for themselves. "The money is all here," he said. The issue is reallocating it."

But Dr. Vagelos didn't buy the argument. Savings might be seen, but only in the long run, he said.

Ms. Kanter, though, argued that if the Vineyard model can successfully incorporate information technology, there would be efficiencies realized and costs cut. The author, most recently of a book titled eVolve!, she said that while technology is "not a magic bullet, it is an extremely important catalyst for change."

Money is just one piece of the puzzle, and Ms. Kanter cautioned that the model will not flourish if people don't invest in it. Dr. Silberstein said the foundation is looking to raise $2 million over the next 18 months.

But even more important, panelists and members of the audience said, is tapping the intellectual capital on the Island. Diana Barrett, head of Spaulding Rehabilitation Hospital and a professor at Harvard who led a workshop earlier in the day, encouraged people to take a small number of ideas and "do them right."

"And you need to have the right people at the table," she said. "On the Vineyard, you can do that."